Longitudinal Assessment Using Entrustable Professional Activities: Key Steps for Implementation in Dental Education

Curriculum evolution calls for incorporating contemporary pedagogical practice. In 2021, the UNC ASOD began the implementation of a new curriculum. One of the unique aspects was a shift from traditional single competency assessments to a longitudinal assessment system using entrustable professional activities (EPAs) for summative entrustment decisions. This paper describes the process and outcomes of determining entrustment and practice readiness for the dental Class of 2024.

A six-step process leading to determination of practice readiness is outlined, with the final step culminating in summative decisions for entrustment and readiness for safe and independent practice post-graduation.

All 91 (100%) learners achieved Statements of Awarded Responsibility (STARs) or competence in all EPAs by graduation, meeting thresholds, and practice readiness criteria. This progression varied by EPA, with some tasks completed earlier in the curriculum and others requiring more time or being impacted by the timing of supplemental assessments. Delays in STAR designation occurred for four learners. No STARs were rescinded.

A longitudinal assessment framework with multiple assessments by multiple evaluators on cases of varying complexity in an authentic work-based environment was successful in preparing practice-ready graduates and ensuring the capability of learners to safely and independently perform professional tasks. Monitoring learners' performance quality, independence, and progression over time and in varying contexts contributes to a greater ability to ascertain learners' practice readiness. The EPA framework facilitated operationalizing longitudinal assessment by providing a comprehensive and future-focused approach to evaluating clinical competence and ensuring public trust.